Targeting the pedunculopontine nucleus

A new neurophysiological method based on somatosensory evoked potentials to calculate the distance of the deep brain stimulation lead from the Obex

Angelo Insola, Massimiliano Valeriani, Paolo Mazzone

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND:: Pedunculopontine tegmental nucleus (PPTg) deep brain stimulation (DBS) has been used in patients with Parkinson disease. OBJECTIVE:: To verify the position of the DBS lead within the pons during PPTg targeting. METHODS:: In 10 Parkinson disease patients undergoing electrode implantation in the PPTg, somatosensory evoked potentials were recorded after median nerve stimulation from the 4 DBS electrode contacts and from 2 scalp leads placed in the frontal and parietal regions. RESULTS:: The DBS electrode recorded a P16 potential (latency at contact 0, 16.33 ± 0.76 ms). There was a P16 latency shift of 0.18 ± 0.07 ms from contact 0 (lower) to contact 3 (upper). The scalp electrodes recorded the P14 far-field response (latency, 15.44 ± 0.63 ms) and the cortical N20 potential (latency, 21.58 ± 1.42 ms). The P16 potentials recorded by the intracranial electrode contacts are generated by the volley traveling along the medial lemniscus, whereas the scalp P14 potential represents a far-field response generated at the Obex level. Considering that the distance between the electrode contacts 0 and 3 is 6 mm, the distance of the electrode contact 0 from the Obex (ΔObex) was calculated by the equation: ΔObex = 6 × Δlatency P14- PPTg0/Δlatency PPTg0-PPTg3. The Obex-to-brainstem electrode distance obtained by the neurophysiological method confirmed that the electrode was located within the pons in all patients. Moreover, this distance was very similar to that issued from the individual brain magnetic resonance imaging. CONCLUSION:: Somatosensory evoked potentials may be a helpful tool for calculating the macroelectrode position within the pons during PPTg targeting.

Original languageEnglish
JournalNeurosurgery
Volume71
Issue numberSUPPL.1
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Deep Brain Stimulation
Somatosensory Evoked Potentials
Electrodes
Pedunculopontine Tegmental Nucleus
Pons
Scalp
Parietal Lobe
Median Nerve
Brain Stem
Reaction Time
Parkinson Disease
Magnetic Resonance Imaging
Brain

Keywords

  • Deep brain stimulation
  • Medial lemniscus
  • Pedunculopontine tegmental nucleus
  • Pons
  • Somatosensory evoked potential

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

@article{ea6e48186c394933b56cd56119fb4f07,
title = "Targeting the pedunculopontine nucleus: A new neurophysiological method based on somatosensory evoked potentials to calculate the distance of the deep brain stimulation lead from the Obex",
abstract = "BACKGROUND:: Pedunculopontine tegmental nucleus (PPTg) deep brain stimulation (DBS) has been used in patients with Parkinson disease. OBJECTIVE:: To verify the position of the DBS lead within the pons during PPTg targeting. METHODS:: In 10 Parkinson disease patients undergoing electrode implantation in the PPTg, somatosensory evoked potentials were recorded after median nerve stimulation from the 4 DBS electrode contacts and from 2 scalp leads placed in the frontal and parietal regions. RESULTS:: The DBS electrode recorded a P16 potential (latency at contact 0, 16.33 ± 0.76 ms). There was a P16 latency shift of 0.18 ± 0.07 ms from contact 0 (lower) to contact 3 (upper). The scalp electrodes recorded the P14 far-field response (latency, 15.44 ± 0.63 ms) and the cortical N20 potential (latency, 21.58 ± 1.42 ms). The P16 potentials recorded by the intracranial electrode contacts are generated by the volley traveling along the medial lemniscus, whereas the scalp P14 potential represents a far-field response generated at the Obex level. Considering that the distance between the electrode contacts 0 and 3 is 6 mm, the distance of the electrode contact 0 from the Obex (ΔObex) was calculated by the equation: ΔObex = 6 × Δlatency P14- PPTg0/Δlatency PPTg0-PPTg3. The Obex-to-brainstem electrode distance obtained by the neurophysiological method confirmed that the electrode was located within the pons in all patients. Moreover, this distance was very similar to that issued from the individual brain magnetic resonance imaging. CONCLUSION:: Somatosensory evoked potentials may be a helpful tool for calculating the macroelectrode position within the pons during PPTg targeting.",
keywords = "Deep brain stimulation, Medial lemniscus, Pedunculopontine tegmental nucleus, Pons, Somatosensory evoked potential",
author = "Angelo Insola and Massimiliano Valeriani and Paolo Mazzone",
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language = "English",
volume = "71",
journal = "Neurosurgery",
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T2 - A new neurophysiological method based on somatosensory evoked potentials to calculate the distance of the deep brain stimulation lead from the Obex

AU - Insola, Angelo

AU - Valeriani, Massimiliano

AU - Mazzone, Paolo

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N2 - BACKGROUND:: Pedunculopontine tegmental nucleus (PPTg) deep brain stimulation (DBS) has been used in patients with Parkinson disease. OBJECTIVE:: To verify the position of the DBS lead within the pons during PPTg targeting. METHODS:: In 10 Parkinson disease patients undergoing electrode implantation in the PPTg, somatosensory evoked potentials were recorded after median nerve stimulation from the 4 DBS electrode contacts and from 2 scalp leads placed in the frontal and parietal regions. RESULTS:: The DBS electrode recorded a P16 potential (latency at contact 0, 16.33 ± 0.76 ms). There was a P16 latency shift of 0.18 ± 0.07 ms from contact 0 (lower) to contact 3 (upper). The scalp electrodes recorded the P14 far-field response (latency, 15.44 ± 0.63 ms) and the cortical N20 potential (latency, 21.58 ± 1.42 ms). The P16 potentials recorded by the intracranial electrode contacts are generated by the volley traveling along the medial lemniscus, whereas the scalp P14 potential represents a far-field response generated at the Obex level. Considering that the distance between the electrode contacts 0 and 3 is 6 mm, the distance of the electrode contact 0 from the Obex (ΔObex) was calculated by the equation: ΔObex = 6 × Δlatency P14- PPTg0/Δlatency PPTg0-PPTg3. The Obex-to-brainstem electrode distance obtained by the neurophysiological method confirmed that the electrode was located within the pons in all patients. Moreover, this distance was very similar to that issued from the individual brain magnetic resonance imaging. CONCLUSION:: Somatosensory evoked potentials may be a helpful tool for calculating the macroelectrode position within the pons during PPTg targeting.

AB - BACKGROUND:: Pedunculopontine tegmental nucleus (PPTg) deep brain stimulation (DBS) has been used in patients with Parkinson disease. OBJECTIVE:: To verify the position of the DBS lead within the pons during PPTg targeting. METHODS:: In 10 Parkinson disease patients undergoing electrode implantation in the PPTg, somatosensory evoked potentials were recorded after median nerve stimulation from the 4 DBS electrode contacts and from 2 scalp leads placed in the frontal and parietal regions. RESULTS:: The DBS electrode recorded a P16 potential (latency at contact 0, 16.33 ± 0.76 ms). There was a P16 latency shift of 0.18 ± 0.07 ms from contact 0 (lower) to contact 3 (upper). The scalp electrodes recorded the P14 far-field response (latency, 15.44 ± 0.63 ms) and the cortical N20 potential (latency, 21.58 ± 1.42 ms). The P16 potentials recorded by the intracranial electrode contacts are generated by the volley traveling along the medial lemniscus, whereas the scalp P14 potential represents a far-field response generated at the Obex level. Considering that the distance between the electrode contacts 0 and 3 is 6 mm, the distance of the electrode contact 0 from the Obex (ΔObex) was calculated by the equation: ΔObex = 6 × Δlatency P14- PPTg0/Δlatency PPTg0-PPTg3. The Obex-to-brainstem electrode distance obtained by the neurophysiological method confirmed that the electrode was located within the pons in all patients. Moreover, this distance was very similar to that issued from the individual brain magnetic resonance imaging. CONCLUSION:: Somatosensory evoked potentials may be a helpful tool for calculating the macroelectrode position within the pons during PPTg targeting.

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